Psychology and mental health

Risk factors for needle sharing among methadone-treated patients

Article Abstract:

Considerable public attention has been focussed on the role of intravenous drug users in the spread of AIDS. Intravenous drug use had been identified as a leading risk factor for AIDS in the US. Perhaps the most important related factor is needle sharing, a frequent behavior within this group. The present investigation studied the characteristics of patients in a methadone maintenance program (a drug abuse treatment in which methadone is given orally to replace another drug such as heroin) who continued to share needles. Data were collected from 323 subjects participating in an ongoing study of the effectiveness of methadone treatment. The mean age of subjects was 38 years, 70 percent were male, and about 47 percent were white and 47 percent were black. Forty percent of the subjects reported using heroin during the month prior to data collection; 47 percent reported cocaine use during the prior month; and 51 percent said they had used benzodiazepines during this period. Twenty percent of the subjects reported having shared needles during the past six months, and attributed this behavior to difficulty obtaining new needles. This subgroup had more severe drug problems, higher rates of legal difficulties, and higher levels of psychiatric symptoms than other methadone maintenance subjects interviewed. It is concluded that the subgroup of methadone maintenance patients who continue to share needles appear to be more disturbed than other methadone maintenance patients. More intensive psychiatric services might be offered to this subgroup. Efforts to reduce needle sharing might best be focused on this subgroup. (Consumer Summary produced by Reliance Medical Information, Inc.)

Efficacy of combinations of intramuscular antipsychotics and sedative-hypnotics for control of psychotic agitation

Article Abstract:

The use of drugs to calm potentially violent hospital patients is frequently warranted. The use of haloperidol, an antipsychotic, with lorazepam, a sedative-hypnotic, has been noted to decrease the required daily maintenance dose of antipsychotic by 50 percent, while decreasing side effects and precipitating quicker sedation. Three studies of three different antipsychotic/sedative-hypnotic protocols for treatment of psychotic agitation were conducted at a public teaching hospital in Texas. Immediate treatment for aggravated behavior was indicated for the 33 subjects studied. The degree of agitation was measured at onset and at 30 minute intervals. Haloperidol and lorazepam were chemically compatible and could be injected into muscle via the same syringe. Thirty-one out of 33 patients receiving this treatment were successfully sedated. The other two patients were eventually sedated, with a higher dose. A second study group consisted of 21 patients treated with haloperidol, 23 with lorazepam, and 24 with both. The combination therapy was significantly better in achieving quick, long-lasting sedation, at lower doses and with rare side effects, than either drug alone. It was also noted that patients with a higher degree of agitation were harder to sedate. A third study tested different combinations for similar results and found them to be consistent throughout varied antipsychotic/sedative-hypnotic combinations. Giving the drugs intramuscularly was preferred because of their convenience when working with severely agitated patients.

Methadone is a replacement drug given to opiate addicts in 689 outpatient treatment programs throughout the United States. Many patients on methadone continue to abuse cocaine. One study showed shown that the antidepressant desipramine was useful in treating cocaine dependence, and consequently desipramine was added to the treatment of a group of methadone patients who were abusing cocaine. Very low doses of desipramine caused an antidepressant response or side effects in the methadone patients. The blood serum levels were also much higher than expected at the doses given. Since it is possible that methadone patients may be simultaneously being treated for depression, an understanding of the combined effect is crucial. To further understand the methadone-desipramine drug interaction, the effects of the drug were studied in five volunteer patients. All five patients showed higher serum levels (108 percent) of desipramine when taking both methadone and desipramine than when taking desipramine alone, which was consistent with complaints of side effects at low doses in the original clinic population. It is suggested that blood levels of desipramine be monitored when this drug combination is used.